Tuesday, Nov 15 2011
• 10 a.m. (ET)

The Looming Worldwide Diabetes Epidemic

A new report predicts one in 10 adults worldwide could have diabetes by 2030. More than 350 million people already have the disease. For years, global resources have been aimed at fighting infectious diseases like malaria and swine flu. Now, developing countries are ill-equipped to provide the long-term care needed for diabetes patients. In the United States, the Centers for Disease Control and Prevention (CDC) projects one in three Americans will have diabetes by 2050. While diabetes awareness has increased in the U.S., more than 25 percent of Americans don’t even know they have it. Diane and her guests examine the causes and costs of the diabetes epidemic and efforts to reverse the trend.

Guests

Leonor Guariguata
Epidemiologist, International Diabetes Federation

Maya Rockeymoore
Director, Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation

Transcript

10:06:56

MS. DIANE REHMThanks for joining us. I'm Diane Rehm. More than 350 million people worldwide have been diagnosed with diabetes. Health officials say it now kills one person every seven seconds. Diabetes costs the world economy an estimated $465 billion. Most of these cases are adult onset diabetes linked to obesity and a sedentary lifestyle. Joining me in the studio to talk about the looming global diabetes epidemic: Dr. Judith Fradkin of the National Institutes of Health, Maya Rockeymoore of Leadership for Healthy Communities and Dr. Rita Kalyani of Johns Hopkins University.

10:07:59

MS. DIANE REHMWe will invite your calls, questions, 800-433-8850. Send us your email at drshow@wamu.org. Joining us now by phone from Brussels is Leonor Guariguata of the International Diabetes Foundation. Good morning to you.

10:08:29

MS. LEONOR GUARIGUATAGood morning, Diane.

10:08:30

REHMLeonor, if you could tell us about the report you released yesterday, just how big a problem is diabetes worldwide?

10:08:44

GUARIGUATAWell, we know that no country is free from diabetes. No country has diabetes under control. From previous reports that we've been producing, we just see an increase in trend over several years, and it keeps getting bigger and bigger with no end in sight at the moment.

10:09:04

REHMSee as behind the surge worldwide?

10:09:09

GUARIGUATAWell, the -- we can certainly say that the numbers are increasing for the next 20 years as well. We can expect up to 552 million people, just adults, to have diabetes by the year 2030.

10:09:24

REHMBut what do you see as causing this?

10:09:29

GUARIGUATAWell, the drivers of the epidemic, certainly people are living longer. So as people get older, they have a greater chance of having diabetes. But also, changes in lifestyle, increases in obesity, people are more sedentary, moving into cities as well, which causes these changes in lifestyle, are the biggest drivers.

10:09:51

REHMWhat about Africa? Why is there such a large increase there?

10:09:59

GUARIGUATAWell, what we can see from Africa, it's not so much that the absolute numbers are increasing -- are so high at the moment, but the projected increase is so large because this is a part of the world that we can expect to develop very quickly over the next few years. They will have much more increases in life expectancy as infectious diseases come under control, but they're also experiencing rapid urbanization, which is really pushing diseases like diabetes through the roof there.

10:10:30

REHMSo are you talking about the kind of dietetic habits?

10:10:36

GUARIGUATAYes, certainly.

10:10:37

REHMSo how is Africa reacting to the influx of food from around the world?

10:10:48

GUARIGUATAWell, I think lifestyles are changing pretty dramatically there. People are moving away from eating traditional foods and sort of eating more processed foods. They're moving into cities at a very rapid pace as well. So those things combined are certainly causing diabetes to really increase pretty rapidly there.

10:11:10

REHMSo, finally, what do you think the global response should be focusing on?

10:11:18

GUARIGUATAWell, with diabetes, the nice thing is -- to some degree, is that we know what the solutions are. We know which drugs work. We have a lot that are safe, that have been around for many years and are very affordable and cost-effective. We need governments to put their commitment forward to really step up and implement a health-in-all-policies approach to diabetes and to chronic conditions in general.

10:11:45

REHMLeonor Guariguata of the International Diabetes Foundation, thank you so much.

10:11:54

GUARIGUATAThank you.

10:11:55

REHMAnd turning to you, Judy Fradkin, we've already had a number of tweets asking us to differentiate between Types 1 and Type 2 diabetes.

10:12:13

DR. JUDITH FRADKINSo Type 1 diabetes is the form that used to be called juvenile onset diabetes. Type 2 diabetes used to be called adult onset diabetes. We no longer use those terms because we know that Type 1 can occur at any age, and, unfortunately, Type 2 diabetes is now occurring in children, particularly in adolescents. So we distinguish between the two based on the cause of the diabetes. And in Type 1 diabetes, it's an autoimmune disease in which there is an autoimmune attack on the beta cells in the pancreas that make insulin, destroys those beta cells.

10:12:54

DR. JUDITH FRADKINAnd the children or young adults with Type 1 diabetes generally produce little, if any, insulin and require insulin for life. Type 2 diabetes, on the other hand, usually starts with insulin resistance. As people develop obesity, the fat tissue actually makes inflammatory molecules and factors that make the body more resistant to the action of insulin. Initially, we can compensate and make more insulin. But, gradually, the beta cell loses the ability to make insulin, and patients go on to develop Type 2 diabetes.

10:13:35

DR. JUDITH FRADKINSo with Type 2 diabetes, we really know the drivers, which generally tend to be sedentary lifestyle and overweight. With Type 1 diabetes, we're looking very hard to try to find the causes, so we can develop a prevention strategy.

10:13:50

REHMNow, I gather with Type 1 -- is the child born with this diabetes?

10:13:59

FRADKINNo. The child is born often with a genetic predisposition to develop diabetes, but then there is some factor in the environment that interacts with that genetic predisposition. We're trying to find out. If it's a virus, we want to be able to develop a vaccine. We think there may be dietary factors, in which case we could change the diet. But we know that there are environmental factors for Type 1 in addition because Type 1 is also increasing.

10:14:27

FRADKINSo, I mean, the number of people with Type 1 is much less than the number of people with Type 2, but the rate of Type 1 is also rising, which suggests that there is some environmental trigger, which we have to discover.

10:14:38

REHMAnd then there is also Type 3?

10:14:42

FRADKINI'm not sure if by Type 3 you mean gestational diabetes.

10:14:45

REHMYes, I did.

10:14:46

FRADKINBut that is the third major form of diabetes, and that is becoming increasingly prevalent and is extremely troublesome because we've learned now that problems both to the mother and to the baby occur at lower levels of blood glucose than were previously recognized. And so the American Diabetes Association has recently changed its diagnostic criteria for gestational diabetes so that about one in seven pregnancies is affected by gestational diabetes.

10:15:18

FRADKINAnd those women have a very high risk of going on to develop Type 2 diabetes, but we have very effective interventions that can prevent that. And so we need to get the word out about those preventive interventions.

10:15:31

REHMAnd, Rita Kalyani, how do you see this growth in the occurrence of diabetes in this country? Is it primarily dietetically based?

10:15:47

DR. RITA KALYANISo, as Judy mentioned, we know that family history is certainly a strong component of Type 2 diabetes, but that's only one risk factor. And, certainly, sedentary behavior and dietary habits contribute to the development. And as we've already heard, we really need to address changes in lifestyle, particularly increasing physical activity and dietary habits need to improve. The current American Diabetes Association guidelines recommend 150 minutes of aerobic activity per week and 7 to 10 percent weight loss for those who are at risk of diabetes to reduce the development.

10:16:25

REHMBut, of course, there are an awful lot of people walking around who neither know they're at risk, nor do they know they even have it.

10:16:36

KALYANIThat's right. So a lot of our effort is also based on education of the community and those who might be at risk, to really educate them on the risk factors for diabetes, to have screening programs in the community where people can come and be identified. That certainly goes hand in hand with what we do in clinic.

10:16:55

REHMAnd, Maya Rockeymoore, that's exactly where you come in.

10:16:59

MS. MAYA ROCKEYMOOREAbsolutely. For the last four decades, we've seen a dramatic increase in the United States of overweight and obesity, which is a primary risk factor for Type 2 diabetes. And with that, you've got both sides of the energy balance equation that are a factor here, whether or not you're physically active and what kinds of foods you're eating. What does your diet consist of? Is it high fat? Is it high calorie, a lot of carbs?

10:17:24

MS. MAYA ROCKEYMOOREAnd we're seeing that people who are not physically active and who are eating and consuming these bad foods are actually increasingly -- and including young children -- getting Type 2 diabetes. So, you know, currently, the report that just came out said that one in 10 adults globally are expected to have diabetes in a couple of decades, but it's already the case in the United States. One in 10 adults in the United States currently have diabetes. And the projection is, by the year 2050, the CDC expects that one in three adults will have this disease in this country.

10:18:03

MS. MAYA ROCKEYMOORESo we've got a major crisis here because this has direct implications for not only personal health but also longevity and also cost to the nation. Health care costs that are related to preventable chronic diseases like Type 2 diabetes are actually spiraling out of control. And if we don't get a handle on this, then we're going to have a major problem.

10:18:27

REHMMaya Rockeymoore, she's director of Leadership for Healthy Communities. We'll take a short break. We've got lots of folks on the line. We'll try to take as many of your calls as possible.

10:20:04

REHMWelcome back. As we talk about the looming diabetes epidemic not only in this country but, indeed, around the world, joining us by phone from her office in Atlanta is Ann Albright. She is with the Centers for Disease Control and Prevention. Good morning, Ann.

10:20:30

MS. ANN ALBRIGHTGood morning, Diane. It's a pleasure to be here.

10:20:32

REHMThank you. We've heard so much about the scale of the diabetes epidemic worldwide. What kinds of interventions are working in that global battle against diabetes?

10:20:50

ALBRIGHTWell, I think because it's a multi-pronged problem, we do need complimentary strategies to really get a handle on this. And so there are certainly things that can and should be done and need to be escalated are things that do look at the environment in which people are living and working and living their lives. So there are efforts in various places to try to make healthier food options more widely accessible, more widely available, more safe places for people to be physically active in their daily life, policies that will help support those kinds of broad, population-wide, general population strategies.

10:21:30

ALBRIGHTThose will hopefully help a number of people at lower risk prevent their development of Type 2 diabetes, and it certainly will help those who are higher risk and those that have diabetes lead healthier lives. As you move along that continuum and we get to people who are already at high risk, they have something we refer to as pre-diabetes. Their blood glucose is already elevated but not yet high enough to have diabetes.

10:21:55

ALBRIGHTWe've got the strongest research for that group, and that is really a lifestyle intervention. That's a structured intervention that seeks to have -- help people lose 5 to 7 percent of their body weight and get about 150 minutes of physical activity a week and also some group support.

10:22:13

ALBRIGHTSo, right now, certainly in the U.S., we're building the National Diabetes Prevention Program, and we're learning from other countries, whether it's Australia or Canada or the U.K. or Finland. A variety of places from around the world were all really working to share that information with each other and help develop a cadre of interventions that will, again, work along that whole continuum of risk.

10:22:37

REHMTell me. Are minorities more likely to be diagnosed with Type 2 diabetes here in the U.S.?

10:22:47

ALBRIGHTMinority population, specifically African-American, Hispanic, Latino, American-Indian, some of the Asian populations and Pacific Islander, native Hawaiian populations, are at higher risk of having diabetes, Type 2 diabetes specifically. And so they certainly are at higher risk, and then, of course, that puts them at higher risk for the devastating complications of diabetes.

10:23:11

ALBRIGHTAnd some of the reasons for these racial and ethnic minorities to be at higher risk include genetics that you heard mentioned earlier, being overweight or obese, socioeconomic status and, again, those community and environmental factors, where people live and try to, again, do the things they need to do in their daily lives. Some of those communities are not very supportive and helpful for making healthy lifestyle changes.

10:23:38

REHMAnd, tell me, are complications likely to show up even before somebody notices or knows that they have diabetes?

10:23:52

ALBRIGHTYeah, that's certainly the case for Type 2 diabetes. There are symptoms and risk factors for Type 2 diabetes. Well, there are symptoms for all forms of diabetes, but the risk factors are for Type 2 diabetes. And the unfortunate thing or the challenge here is that many people with Type 2 diabetes either don't actually experience symptoms or they don't necessarily recognize them as symptoms that they need to act upon.

10:24:17

ALBRIGHTAnd so, many times, people are not diagnosed with Type 2 diabetes in particular until they may have had it for quite some time. And then, of course, they may be moving towards some of those complications: changes to their eyes, changes to the sensation or nerves in their feet. They may also have cardiovascular disease. So it is possible, absolutely, for people to begin to develop those complications before their diabetes is diagnosed.

10:24:45

REHMAnd, finally, give me some of the CDC success stories that you've had in combating diabetes.

10:24:54

ALBRIGHTWell, I would list a couple of those. I had mentioned one already, the National Diabetes Prevention Program. The CDC has been authorized by Congress to lead that effort. It builds on the important research and scientific work that NIH has led, and we now have partners, community organizations like the YMCA and others. And we have third party insurers like UnitedHealth Group. And now, others are signing on to provide coverage for this intervention.

10:25:23

ALBRIGHTSo, for the first time ever in the United States, we are actually successfully building a National Diabetes Prevention Program. We're about a year-and-a-half into that effort. And now, there are more than 170 locations around the country serving people with pre-diabetes, and that is a tremendous victory. But the momentum must continue because we've got millions of people that need to be reached.

10:25:46

REHMAnd many of those are on the line with us now. Can you stay on and join with our other guests to answer questions?

10:25:58

ALBRIGHTWould love to. Thank you.

10:25:59

REHMThank you. And here's the first that was posted this morning on Facebook. It's from Margaret. She says, "I developed Type 1 diabetes when I was 5, at 40, received a double transplant -- pancreas, kidney -- after my kidneys failed. Life has been wonderful since getting rid of diabetes, but the medications I was initially on caused me to put on 100 pounds. Now, I'm 40 pounds lighter. I've learned about good, healthy food. Taking the time to prepare my own foods at home is what has made the difference." I wonder if that's how you see it, Rita Kalyani.

10:26:54

KALYANISo it is it true that once diabetes gets under better control, the body is able to better metabolize the glucose and store it for future use as fuel. So weight gain can occur especially with insulin use, underlying the importance of dietary modification and lifestyle. Following a transplant, there are also other medications as well that can further challenge. Glucose levels increase them and making it again much more important to follow careful diet and activity.

10:27:26

REHMWhat about -- Dr. Albright, what about the question of processed foods?

10:27:34

ALBRIGHTWell, certainly, there -- I think, first and foremost, look at the calorie content of food. Certainly, processed foods oftentimes are lower in fiber. They may be higher in fat, higher in salt. So it certainly -- this is, again, kind of a package deal. You have to look at several different factors. And the closer you can pick foods that are, you know, from the vine or from the ground and have more fiber in them, the likelihood is that they will certainly be healthier. But you first really need to be considering the calories in those foods.

10:28:07

REHMAnd, Judy Fradkin, you heard some scary projections from the CDC. What are some of the signs of hope in research from the NIH?

10:28:21

FRADKINWell, I would echo what Ann said about the importance of this large NIH-sponsored trial, the diabetes prevention program, which found that reducing your weight by just about 15 pounds -- people didn't need to get to their ideal body weight. They just needed to make a positive change, and that reduced the risk of developing Type 2 diabetes in people who have pre-diabetes by 58 percent. And that's what CDC is now trying to disseminate around the country.

10:28:49

REHMInteresting.

10:28:53

FRADKINAnd the other point that I want to make is this intervention worked in minorities. Our study population was 45 percent minorities. It worked in women with gestational diabetes. We over-sampled them. And it also worked in people with the high-risk genes for Type 2 diabetes. So genetics is not destiny. Even if you have those high-risk genes, you can overcome it with lifestyle change.

10:29:16

REHMMaya.

10:29:17

ROCKEYMOOREThat's absolutely right. And so we need to have environments that actually support the lifestyle change, right? So in many communities, especially that are high rates of minorities, they have, you know, a lack of access to full-service grocery stores. You know, they call them food deserts. They have an overabundance of fast food restaurants. They have inability to get physical activity because the neighborhoods aren't necessarily safe. So we really need to think of this and look at this from a holistic perspective. What can we do in the community, in schools, certainly, to support healthier choices for all?

10:29:54

REHMRita.

10:29:55

KALYANIIf I could add to that as well, in the clinics, this is integral to what we talk about with our patients. In addition to therapeutic management, all our patients see a nurse educator to talk about the importance of some of these lifestyle changes. They meet with a dietician to talk about dietary habits. It really is a comprehensive care that we need to offer patients, understanding that behavioral modification is just as important as the therapies we prescribe.

10:30:21

REHMMaya.

10:30:21

ROCKEYMOOREAnd for communities of color -- I just want to say this as a person of color, that, you know, often, our relationship to food is through our cultural experience. And, often, the traditional cultural preparation of food is not the best way to prepare food. So in addition to, you know, making sure that we have the community supports, it's about looking at how you can actually change the preparation of the foods you love in a way to make it healthier, so that you're consuming less...

10:30:48

REHMGive me an example.

10:30:49

ROCKEYMOOREWell, let me give you a short story. I went to go visit my parents. They go to African Methodist Episcopal Church in San Antonio, Texas. And it was diabetes Sunday. The American Diabetes Association had inserted inserts into the program of the church. Well, it was also February, which is Black History Month. And so they had soul food Sunday at the same time as diabetes Sunday.

10:31:11

ROCKEYMOORESo right after church, we all went over next door, and then there was the macaroni and cheese. There was the fried chicken. There was everything that you could possibly imagine that was bad for you. And I don't think anybody saw the contradiction, and so...

10:31:23

REHMNobody put two and two together on that one.

10:31:26

ROCKEYMOORENo. And so what we need to understand is that, absolutely, our environments matter, but also we need to really look at, certainly, what we're consuming and how we're preparing that.

10:31:35

REHMAll right. I want to go to the phones now, first to St. Louis, Mo. Good morning, Madeline. You're on the air.

10:31:45

MADELINEHi. I was wondering if your guests could address the relationship between sleep deprivation and/or obstructive sleep apnea with testing and difficulty treating diabetes.

10:31:57

REHMAnn Albright.

10:32:00

ALBRIGHTWell, there's certainly maybe others on the line who would want to address that as well, but there is certainly those who are overweight or obese certainly may end up with sleep apnea and sleep difficulty. There is some research going on that indicates that poor sleep habits may also disrupt metabolism and can certainly contribute to the development of Type 2 diabetes.

10:32:21

REHMInteresting.

10:32:22

ALBRIGHTThe mechanisms are still being understood.

10:32:24

REHMRita?

10:32:25

KALYANIThat's exactly right. So it could go both ways. People who have sleep apnea, more likely to have obesity, insulin resistance, develop diabetes, while those who have diabetes, more likely to have sleep problems as well.

10:32:37

REHMRita Kalyani. She is with the Johns Hopkins Diabetes University. And you're listening to "The Diane Rehm Show." Let's go now to Fort Lauderdale, Fla. Good morning, Venette. (sp?) You're on the air.

10:32:56

VENETTEGood morning, Diane. I really enjoy your show always so much.

10:32:58

REHMThank you. Thank you.

10:33:00

VENETTEAnd I just wanted to mention that sometimes I think that doctors do not, you know, give alternatives to people. They always write a prescription. They don't stress that, you know, lifestyle change and exercise, eating properly, that that would really make an impact because my fiancé was recently diagnosed with that. And to make a long story short, after two weeks, he stopped taking the insulin. And after three weeks, he stopped taking the cholesterol and high blood pressure medication, and his weight dropped 50 pounds.

10:33:38

VENETTEHe -- his -- and when he went back for his checkup, the doctor told him that he was only in 1 percent of his patients that that would happen to. And the thing is, what we did was follow the instructions that were sent home with him. And he started exercising regularly every day, eating three meals a day with some fresh fruit or vegetables and lowering the amount that he eats and nothing out of the ordinary. But I think that people need to take their own health into -- you know, into their hands instead of asking the doctor just to prescribe to them something.

10:34:13

REHMThat's a good point, Judy.

10:34:16

FRADKINSo I think you make a very important point, which is that lifestyle change and diet and exercise is important not just for preventing Type 2 diabetes, but it remains important after diabetes is diagnosed. And we have a study which shows that losing a modest amount of weight in patients with Type 2 resulted in better control of sugar, of blood pressure and of lipids with less use of medications.

10:34:44

REHMInteresting. All right. To Mishawaka, Ind. Good morning, Paul.

10:34:51

PAULGood morning, Diane. It's nice to hear your voice.

10:34:52

REHMThank you.

10:34:55

PAULI actually am 27 years old, and this year I was diagnosed with Type 1 diabetes. And one of the things I noticed, especially in the hospital, they didn't know exactly how to -- they know how to treat -- bring my blood sugar down. They didn't know exactly how to take care of it. They never told me that, especially with Type 1, I have to take insulin every time I eat to counteract the amount of carbs I'm eating. But they weren't even counting my carbs when I was in there.

10:35:20

PAULBut also the one thing I noticed you guys haven't talked about yet was the indicators whether or not you may have diabetes from the symptoms that you could have 'cause I know I ignored my symptoms for at least about a week-and-a-half.

10:35:32

REHMWhat kind of -- what kinds of symptoms were you having?

10:35:37

PAULIt first started out with severe dehydration, which I thought may be just an issue 'cause I hadn't been drinking a lot of water and was working long days during the summer outside. And then I started to get severe leg cramps, which was the lack -- severe lack of potassium in my system. And then once the third major symptom came on, which was my vision was starting to blur -- I couldn't read very well -- that's when I finally said, you know, I need to go see a doctor. I need to find out what's going on.

10:36:03

REHMIndeed. Rita.

10:36:04

KALYANISo I'm glad that you highlighted those symptoms because this is the way we can help people who don't know they have diabetes, you know, get evaluated. So the symptoms that you discussed, very common: frequent urination, frequent thirst. Weight loss we often see as well just prior to the diagnosis because the body is not able to metabolize the glucose due to lack of insulin response. Blurry vision, as you mentioned, fatigue, which be a very non-specific symptom, but, in fact, you know, the body is not as it should be. And that is a very common presenting symptom as well.

10:36:42

REHMI want to go back to our first caller who -- or perhaps the second -- who put on 100 pounds as a result of the insulin. How common is that? Ann Albright.

10:37:01

ALBRIGHTWell, it sounded like her weight gain was a result of the anti-rejection medication that she was on. Those particular drugs do have real challenges with weight gain. There certainly are people who have not had a transplant and who are on insulin may also have some weight gain associated with it. There are some of the other diabetes drugs that may also cause weight gain. But those can be managed by, again, your physical activity and nutrition habits. Lifestyle is a treatment for diabetes.

10:37:35

REHMAll right. Ann Albright of the CDC. Short break, right back.

10:40:04

REHMAnd welcome back. As we talk about the diabetes epidemic worldwide, let's go to James here in Washington, D.C. You're on the air.

10:40:19

JAMESYes. Hi, Diane.

10:40:20

REHMHi.

10:40:21

JAMESI'm 48. I was diagnosed with Type 1.5 diabetes when I -- last year when I was 47. It was just latent autoimmune diabetes on adults. I'm a tall, vegetarian, fit person, and I came down with this. I lost a lot of weight. Drinking a lot is what other people have said. And what I find now is that it is extremely difficult to eat. If I'm at home, I can manage my diet, and I'm fine.

10:40:50

JAMESBut the minute I walk out of the house -- I go into a breakfast place in Spokane, Wash. two weeks ago for my -- when I was visiting my niece, and I get pancakes, hash browns, toast and an egg. And I just -- I find that the entire American diet is kind of built around the idea that we're all going to get diabetes because there's just not enough vegetables and protein and other things. And I'm extremely frustrated with it.

10:41:16

REHMHow about getting on a plane?

10:41:19

ROCKEYMOOREAirports.

10:41:20

REHMAirports. You know...

10:41:24

JAMES(unintelligible)

10:41:24

REHM...when you get on a plane, that's all you get. Maya, what do you think?

10:41:29

ROCKEYMOOREThere are no choices, and this is why public policy is so important. The minute you step outside your home, what's offered in terms of opportunities for what you eat to, you know, opportunities of physical activity depend on what's being offered. And if you're in an airport, you're a prisoner of your environment. And imagine whole communities like airports where you have actually no opportunities to eat healthy foods or get physical activity.

10:41:56

ROCKEYMOOREAnd so what he raises is that we have created an obesogenic culture in this country by, you know, relying on convenience foods, processed foods, fast foods. We have over -- I think -- tilted our society towards those foods that undermine our health, and we do not have enough options out there for supporting healthier lifestyles. And this is what Leadership for Healthy Communities is all about. We're working with policymakers at every level of government to look at what policy leaders can do to help structure and support healthier choices for the public.

10:42:31

REHMI must say I was in a small hotel the other day, and breakfast was -- you know, you could have eggs or anything else, but there was a fruit bar with bananas, with cut-up fresh fruit, which is what people need to have, Maya -- Rita, sorry.

10:42:53

KALYANISo I think this ties in very well, when we talk about the global epidemic of diabetes, because in other parts of the world and developing nations in particular, this is what we're seeing as we see a trend towards urbanization, the availability of high-caloric fast food, sugar, sweets and beverages. And these are countries where they may not be used to having this relative food abundance.

10:43:14

KALYANIAnd Johns Hopkins has a partnership with Trinidad and Tobago where we are working with Trinidad as an example of a developing nation where we see the same social illnesses that we see here: physical inactivity, unhealthy dietary habit. And we need to work not only locally in our country but globally to address what are the particular need of countries around the world.

10:43:37

KALYANIAnd when we talk about diet, we talk about local diets. As Maya mentioned, we need to address what are the local dietary customs. Some customs are more rice-based. Some are more bread-based. And this is very important as we talk about reducing the global diabetes epidemic.

10:43:52

10:43:59

DONALDGood morning, Diane. How are you?

10:44:01

REHMI'm fine. Thanks.

10:44:03

DONALDGood. I was diagnosed with Type 2 diabetes back in 2007, and I am currently 32 years old. But when I was diagnosed, you know, I wasn't -- I didn't think that taking insulin every day was going to be the way out. I just think that, you know, my diet was a big part of it as well. You know, I became a vegetarian, but that didn't help. And then a friend of mine handed me a CD called "Dead Doctors Don't Lie" by Dr. Joel Wallach. And I listened to that CD, and it absolutely changed my life.

10:44:34

DONALDAnd, you know, the biggest thing that he said about most diseases is that it comes from mineral deficiency. And so I started taking some products. And I take 90 essential nutrients and minerals and vitamins every day. And there's, like, 60 minerals -- I mean, 60 minerals, 15 vitamins, 12 essential amino acids and the three essential fatty acids. And I also was taking another supplement. And within two weeks, my blood sugar was under control, and this was two years ago. And I have not been on insulin since.

10:45:04

DONALDI think that the misnomer is that, you know, we can get all the vitamins and minerals and things that we need from the four basic food groups, but, you know, the soils and everything these days are so depleted of the minerals because of the way that they are planting and, you know, not letting crops, not -- I'm sorry, not letting fields rest anymore and…

10:45:22

REHMAll right, Donald. Let me ask you a question if I may. Are you overweight?

10:45:30

DONALDAm I overweight?

10:45:31

REHMYeah.

10:45:32

DONALDNo, ma'am, not anymore. You know, when I...

10:45:33

REHMOkay.

10:45:35

DONALDI -- you know, once I started taking the minerals -- because with the insulin, you know, you have to control your diet, and that was part of it. I was a football player, so I stayed in pretty good shape for most of my life…

10:45:46

REHMOkay. Now, I want to ask Ann Albright about what you said. What's your reaction, Ann?

10:45:54

ALBRIGHTWell, I think, first and foremost, people do need to have a conversation with their health care professionals about these things. There are a variety of options, things that people can try. I think it's important for health care professionals to keep an open mind and have that conversation with people. But it's certainly true this may have helped this caller, but it's not necessarily going to work for everybody. I think there are some, again, medications that have been proven to be effective. They are helpful for people.

10:46:22

ALBRIGHTThey will help them be under control. The important thing is to safely be able to keep your blood sugar, your cholesterol and your blood pressure well managed. Look at the options, but always have that conversation with your health care professional because you want to be sure there aren't any conflicts. Whenever you start taking large amounts of vitamins and minerals, they are in a delicate balance, and you can end up harming -- causing some harm if you're not doing it under some appropriate medical supervision.

10:46:51

REHMAnd what do you think, Maya?

10:46:54

ROCKEYMOOREWell, I absolutely think that, certainly, people should take their health into their own hands and read as much as possible. And it sounds like this worked for him. But, certainly, it sounded like reducing his weight also had a significant role in the situation. And so, I mean, as the doctors have indicated, a healthy weight is a key in order to reverse kind of like the effects of Type 2 diabetes.

10:47:18

REHMAll right. To St. Louis, Mo. Good morning, Nick.

10:47:23

NICKHi. How are you all doing?

10:47:24

REHMFine. Thanks.

10:47:26

NICKYears ago, I worked -- developed an antagonist to insulin growth factor, and, through traveling through the country, I met with a lot of academic scientists and was kind of appalled by physicians who choose to treat their patients with lifestyle changes versus, you know, drug therapy. And I'm curious what global answer to this could be, especially -- you all talked about carbohydrate-rich diets versus diets that are rich in protein. Carbohydrates are cheap. Proteins are expensive. And I especially see this as an issue in developing countries. I'm curious if you can discuss that. Thank you.

10:48:04

FRADKINI don't think it's an issue of lifestyle versus medication. I think that both have to be used appropriately, and people -- health care providers have to be sensitive to the life circumstances of their patients. And if people can't afford a therapy or they can't afford a diet, people need to face that and make a plan with the patient to figure out how they can get something that will help them that they can afford.

10:48:32

REHMMaya.

10:48:33

ROCKEYMOOREBut primary prevention is about lifestyle choices. So if you want to actually avoid actually ever having to get on medications, you can actually manage your health in a way through lifestyle choices. And that means that whatever food is on your plate, you can see it as and treat it as a medicine -- and physical activity, the same way -- so that you never have to get on medication.

10:48:55

REHMRita.

10:48:56

KALYANIAnd, in fact, the current American Diabetes Association guidelines and their algorithm do recommend a combination of lifestyle and medication to begin with recognizing the importance of lifestyle but also recognizing how impractical, sometimes, to incorporate it into a very busy schedule.

10:49:11

REHMAll right. To Homestead, Fla., and to Carol. Good morning to you.

10:49:18

CAROLGood morning, Diane. Thanks for taking my call.

10:49:20

REHMSurely.

10:49:22

CAROLHi. I have been hearing that, mostly, about food changes and, you know, the hard -- the high-carb diet are an issue. But I would like to ask about simply sugar ingestion in drinks and specifically soft drinks. I'd like to know whether or not there are any studies that show, either in the lab or with correlation with people's lifestyle and how much they drink, whether or not soft drinks are related to diabetes frequency.

10:49:49

REHMAnn Albright.

10:49:51

ALBRIGHTWell, probably one of the most common myths about diabetes is that's it's caused by sugar. I think we have to, again, take a step back and understand that many of the foods that contain sugar are also very high in calories, and so sugary beverages are a significant calorie source. Further research -- and there certainly are investigators who are dedicated to this area, and they are committed to this work -- are looking at the actual impact of sugar and what it does metabolically.

10:50:19

ALBRIGHTSo more evidence may come our way that will change that thinking, but I think, at this point, people really do need to look at their entire calorie intake. Excess calories cause excess weight gain. It's the fact that things like sugary sodas, food that doesn't have a lot in nutritional value to it but high in calories, that's what stacks on the weight. And now we know for a fact it's what contributes to the development of Type 2 diabetes.

10:50:44

REHMRita Kalyani, tell me about your diabetes guide. Is it really an app?

10:50:51

KALYANIThat's right. So at Johns Hopkins we have developed a diabetes guide for heath care providers called Point of Care Information Technology. It was initially developed as an app for mobile phones that could be used to help address some of the needs of the global diabetes epidemic. Providers have access to information, literally at their fingertips, while they're seeing the patient in the clinic.

10:51:14

KALYANIAnd often, providers are too busy to look through textbooks but have questions that arise when they see patients. So we have approximately 150 topics written by about 40 to 50 experts spending many fields. And the idea is that providers can look at this guide -- nurses, doctors, educators, anyone who sees a patient with diabetes -- and find the answer they need within minutes.

10:51:36

REHMWhat about the patient him or herself?

10:51:39

KALYANIThere are definitely topics on lifestyle, education, nutrition, guideline for physical activity that would be particularly appropriate for patients, in addition to modules on medications and side effects that, I think, patients would find interesting.

10:51:53

REHMAnd how do individuals go about getting hold of that app?

10:51:59

KALYANISo the diabetes app is available trough most major online retailers, iTunes. We have a print version of the guide available through Amazon and Barnes & Noble as well.

10:52:08

REHMAll right. And at NIH, Judy Fradkin, you've got an 800 number for individuals interested in...

10:52:20

FRADKINStudies to prevent Type 1 diabetes. Because I have to take a bit of issue with what Maya said about lifestyle and diet being able to prevent diabetes. It can't prevent Type 1 diabetes. And we are trying to do studies to prevent Type 1 diabetes and to diagnose it earlier so that we don't have a situation like your caller, who presented with such severe symptoms of Type 1 diabetes.

10:52:44

FRADKINAnd so we have the Type 1 Diabetes TrialNet, which is a network of sites all across the country where family members of people with Type 1 diabetes, who are at increased risk of developing Type 1 diabetes, can go and get a blood test to find out what their risk of developing Type 1 diabetes in the future might be and to enroll in trials.

10:53:00

REHMI see. Okay. And that number we'll have posted on our website is 1-800-242-5836. The acronym is 800-2-HALTDM. (sic) And there will...

10:53:22

FRADKINNo. 1-800-HALTDM-1.

10:53:26

10:53:42

LEEGood morning, Diane. Thank you so much for taking my call. The -- my son was 18 when he got Type 1 diabetes, and shortly after his dog also came down with diabetes. At that time, I contacted the University of Tennessee Veterinarian School, who also had a physician who was for human beings that was looking into the questions of cross-species and Type 1 diabetes. My question for your guest is, has there been any further research for missing link with Type 1 diabetes and a predisposition that crosses species?

10:54:25

REHMAnn Albright.

10:54:27

ALBRIGHTWell, that's certainly worked at -- NIH is probably -- if anybody would be more focused on than certainly what we do at CDC.

10:54:36

REHMJudy.

10:54:37

FRADKINWe are looking at animal models of Type 1 diabetes, but they're more in the nature of mouse models than dog.

10:54:45

REHMI see. Rita.

10:54:48

KALYANIIt is true that animals, just like humans, can get diabetes. And it begs the question of whether there is an environmental factor, particularly if it's in the same family, that could be contributing. Again, the NIH would be the place where that kind of exciting research could be done.

10:55:04

REHMBut isn't the more logical explanation there that an individual who eats those kinds of foods may simply feed them to the dog, and that the dog would, logically, pick up the same kind of problems? That's just my own unprofessional theory.

10:55:26

FRADKINThere is a correlation between pet's weights and owner's weights. You're absolutely right.

10:55:29

10:55:39

MONICAHello, this is very timely for me. I'm meeting with our high school principal in two hours to try to get school lunch nutritional information provided. How important of a tool do the experts believe this is in developing good habits? My son happens to be a Type 1, and I thank the panelist who explained that this cannot be controlled by diet. The dog can get Type 1 diabetes through diet no matter what its owner feeds it.

10:56:12

REHMAll right. Well, Maya, you can talk about school lunch programs.

10:56:18

ROCKEYMOORERight. So this is a major issue in social policy. Last year, the Congress passed the Healthy, Hunger-Free Kids Act. And it was the first major investment in looking at the quality and the nutritional content of what's offered in lunch lines and the breakfast lines and in the vending machines of schools across the country. And the bill was passed. It offered nutritional guidelines for what should be offered that, you know, were consistent with what's considered proper for good health.

10:56:47

ROCKEYMOOREAnd the regs have been written, and there's now a contestation between policymakers about whether or not kids can have French fries in school and some other issues. So, right now, we're looking at towards implementation of a Healthy, Hunger-Free Kids Act.

10:57:01

REHMSo, Monica, take this program with you with your meeting to -- with the principal. I think you might have some good ammunition. Thanks for calling. And to all of you, Dr. Judith Fradkin, Maya Rockeymoore, Dr. Rita Kalyani and Ann Albright, thank you all so much. Thanks for listening. I'm Diane Rehm.

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